Permits - Permit# 11-16B - 2447 Black Lake Road - 1/1/2011CIT' OF SPRING PARK
4349 Warren Avenue Spring Park, MN 55384
Phone (952) 471-9051 Fax (952) 471-9160
13UILDING PERMIT
Noise Ordinance In Effect:
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Monday - Friday before 7 a.m.
and afterl0.p.m.
Weekends/Holidays. before 7
a.m. and after 8 p.m.
DATE
CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL
SITE ADDRESS l� (r PID
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CONTACT NAME - PHONE - 9MAIL - FAX
ARCHITECT (if Recuired) Name/ Address I Qity/ State/Zia /Phone
CONTRACTOR Nilme/Address/
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CONTACT NAME - HONE - EMAIL -FAX
CONTRACTOR LICENSE # Q4!�)
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TYPE OF WORK
New Home
o Deck
❑ Re -Roof
...._......... —.....----
❑ Commercial Residential
❑ Addition
❑ Fence Height:
❑ Re -Side
EST. VALUA ON OF WORK
❑ Remodel
❑ Finish Basement
❑ Pool
❑ Stucco Demo
❑ Ret. Wall Height:
❑ Window Replacement
$ I
Building Height: Feet
❑ Accessory Structure
10 Stucco
Other: /1
# of Stories:
SCOPE OF WORK:
Use of.Building:
OA
nA-ny le
signature of fits application by the legal property owner or a licensed contractor, as the ovmefs representative Is required and authorim the City Zoning Adm4listrator or designee and the City _ ng official. or designee
o enter upon the property to perform needed Inspections. Entry maybe without prbr notice; I hereby acknowledge that I have read this application and state that all information is true and correct to the best of my
knowledge'. I further agree that all work performed will be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the City and the laws of the state of Minnesota regarding actions
taken pursuant to this peon(. 1 agree to pay all plan review fees even If 1 choose not to proceed with the work. Permit expires when work is not commenced with 76Q days Firm date of permit Issued, or 0 building and
work is suspended, abandoned or not Inspected for 180 days. Work beyond or without a permk or Inspection wig be subWt to a pariatty.
Call MNSPECT for inspects at (952) 44 - 20. (2 ur Notice) 8:00 a.m. - 4:30 p.m.
— — ..........
SIGNATURE OF APPLICANT:
PRINTED NAME:-
�4 &
f i%i,,.8 .IRT'f
LEGAL DESCRIPTION: Loth Block Addition Zoning
Valuation of Permit: $
Lot Area:
OCCUP. TYPE: CONST. TYPE: CODE`. BLDG SPRINKLED
Yes I No
SETBACKS: REQUIRED ft .
ACTUAL ft
" 4
Permil Fee:$
__. Front_(ROW)
_,. _._..,.__................._..
Side
Side
.._.... - ._-
Plan Check F.ee:$
State Surcharge:$
-.. - -- ---
-- _ —
Site Insp. Fee:$
Muni.SE/WA Fee:$
SAL Fee.$
WAc charge:$
Comer
Lakeshore
Wetland
_
Other
sewer a H2o took -up $'
sewer 8 ciao D ls=nect:$
I
TOTAL DUE:,
Water Meter :$
Other :$
Paid
Date
j Receipt No. --
!By
BUILDING APPROVAL BY.•'.
CITYAPPROVAL BY.;
I ;DATE:
I ` TIME:
DATE:
TIME:
Alf new construction andlor dwelling expansion shall require a certified survey dated within five years of application.
AtI new construction andlor dwelling we anion will be subject to contracted planner review and may addtothe review lime.
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June 21, 2011
JOBSITE: 2447 BLACK LAKE DRIVE
SCOPE OF WORK: Glowing Hearth & Home was hired by Minnetonka Custom Homes to install a
freestanding woodburning stove. Hearthstove fireplace, model 8021-MB. We are to set stove and vent thru
ceiling/roof.
Please call me with any questions and the dollar amount of the permit.
Thank you,
Annette Williams
Glowing Hearth & Home
952-492-9276
952-492-6006 fax